MEDICARE: MILLICENT ANN SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1841097185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILLICENT ANN SMITH

Provider Business Mailing Address
First Line	:	736 S ELM ST
Second Line	:
City	:	BELLE PLAINE
State	:	MN
Zip	:	56011-3302
Country	:	US
Telephone Number	:	612-246-0210
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 HIGHWAY 7
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-5817
Country	:	US
Telephone Number	:	612-756-9107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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Directions to “ MILLICENT ANN SMITH ” Practice Location

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